KattyJamison
Одна из немногих статей, где вообще упоминается другая точка зрения. Мы растём над собой, не иначе. Нет, я тоже считаю, что в существующей системе здравоохранения нужны реформы. Но вот только не в стиле "отобрать и поделить", если можно...
на английскомFrom Medscape Medical News
United States Still Lags in Health Quality Improvements
Mark Crane
October 20, 2011 — The US healthcare system has failed to improve in most quality measures during the past 5 years, with significant erosion in access to care and affordability of care, according to a new scorecard compiled by a liberal advocacy group.
The third national scorecard from the Commonwealth Fund Commission on a High Performance Health System finds that the United States is failing to keep up with gains in health outcomes made by other countries. "The U.S. ranks last out of 16 industrialized countries on a measure of mortality amenable to medical care (deaths that might have been prevented with timely and effective care), with premature death rates that are 68 percent higher than in the best-performing countries," the report found. "As many as 91,000 fewer people would die prematurely if the U.S. could achieve the leading country rate."
Quality of care still varies widely across the country. For example, despite a 13% overall drop in hospital admissions for heart failure and pediatric asthma from 2004 to 2007, rates vary 2- to 4-fold across states, the report said.
"The U.S. still spends up to twice as much on health care as other high-income countries, but too often fails to deliver what people need — timely access to high quality, efficient health care," Maureen Bisognano, president and chief executive officer of the Institute for Healthcare Improvement, and a Commonwealth Fund Board and commission member, said in a release. "The places in the U.S. and around the world that set the benchmarks prove that it is possible to do better."
The report, "Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011," measures the US healthcare system across 42 key indicators of quality, access, efficiency, equity, and healthy lives. The scorecard compares US average performance with rates achieved by the top 10% of "U.S. states, regions, health plans, and hospitals or other providers, as well as from the top-performing countries," according to the report.
The 2011 score of 64 out of 100 was slightly below both the overall score of 67 in the first national scorecard, published in 2006, and the score of 65 from in the second scorecard, published in 2008. The authors note that latest data in the scorecard primarily fall between 2007 and 2009, before enactment of the Affordable Care Act. They also point out that provisions in the new law target areas for improvement in which the United States falls short, particularly in access to care, affordability of care, and support for more patient-centered, coordinated care.
Despite the overall score, the report found notable gains in quality of care in areas that have been the focus of public reporting or collaborative improvement initiatives. For example, 50% of adults with high blood pressure had it under control in 2007 to 2008 compared with only 31% in 1999 to 2000. Hospital quality indicators for treatment of heart attack, heart failure, and pneumonia, as well as prevention of surgical complications, have improved substantially across the country since hospitals began publicly reporting their quality data through a federal Web site.
"If we target areas where we fall short and learn from high-performing innovators within the United States, we should see significant progress in the future," said Commonwealth Fund Commission Chair David Blumenthal, MD, professor of medicine and healthcare policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston. "The Affordable Care Act and investments in information systems offer the potential for rapid progress in areas like adoption and use of health information technology, safer care, and premature deaths from preventable complications."
The Commonwealth Fund strongly supported passage of the Affordable Care Act.
The scorecard found that in many areas, US health system performance has either failed to improve or has declined over time.
By 2010, 81 million adults (44% of all adults younger than 65 years) were either underinsured or uninsured at some point during the year, up from 61 million in 2003. For those with insurance, premiums rose far faster than incomes. In 2003, a majority of people (57%) lived in a state where health insurance premiums averaged less than 15% of average (median) incomes. By 2009, only 4% of the population lived in such states. In addition, by 2010, 40% of working-age adults had medical debt or faced problems paying medical bills, which was up from 34% in 2005.
"The U.S. also does particularly poorly on measures of health system efficiency," according to a news release. "This area of the scorecard includes such issues as evidence of duplicative services, high rates of hospital readmissions, relatively low use of electronic information systems, and high administrative costs. This low score translates into significant costs to the health care system. For example, the scorecard finds that the U.S. could save $55 billion a year if it could lower insurance administrative costs to the average of administrative costs in other countries with mixed public-private insurance systems."
Other areas of concern include:
Of nonelderly adults, 44% report they did not have an accessible primary care provider in 2008, and only half of adults received all recommended preventive care.
The average US infant mortality rate is more than 35% higher than the rates achieved in the best states, and rates in even the best states are still twice as high as those in other countries.
Rehospitalization rates failed to improve and varied widely, with 20% of Medicare patients hospitalized for certain conditions or procedures readmitted within 30 days in both 2003 and 2009. Rates in the highest-rate regions were 50% higher than in the lowest-rate regions.
Conservative health policy leaders argue that Commonwealth Fund scorecards are biased. "They consistently downplay the incredible quality of care Americans receive when they are sick," Grace-Marie Turner, president of the Galen Institute, told Medscape Medical News. "We have higher rates of people surviving breast cancer, prostate cancer, and cardiovascular disease than anywhere in the world.
"Take the infant mortality statistics," she said. "In many other countries, a baby has to be alive for days before it's even counted as a live birth. These countries don't engage in the heroics we do to save babies. That's why their rate appears better than ours, but it's highly deceptive.
"We have problems that need to be fixed in healthcare," Turner said. "But trying to tell Americans that we have a terrible health system and disparaging it due to Commonwealth's political agenda is just not credible."
"This is just the latest installment of Commonwealth's continuing work to selectively criticize the private sector side of American healthcare," Thomas Miller, resident scholar at the American Enterprise Institute told Medscape Medical News. "Note that the fund doesn't invest the same effort in criticizing the fee-for-service Medicare or expanding Medicaid and CHIP programs, or the hoped-for fuller implementation of the Affordable Care Act, because those are considered politically occupied territories. These scorecards use flawed measures, skewed 'evidence,' and rigged comparisons."
на английскомFrom Medscape Medical News
United States Still Lags in Health Quality Improvements
Mark Crane
October 20, 2011 — The US healthcare system has failed to improve in most quality measures during the past 5 years, with significant erosion in access to care and affordability of care, according to a new scorecard compiled by a liberal advocacy group.
The third national scorecard from the Commonwealth Fund Commission on a High Performance Health System finds that the United States is failing to keep up with gains in health outcomes made by other countries. "The U.S. ranks last out of 16 industrialized countries on a measure of mortality amenable to medical care (deaths that might have been prevented with timely and effective care), with premature death rates that are 68 percent higher than in the best-performing countries," the report found. "As many as 91,000 fewer people would die prematurely if the U.S. could achieve the leading country rate."
Quality of care still varies widely across the country. For example, despite a 13% overall drop in hospital admissions for heart failure and pediatric asthma from 2004 to 2007, rates vary 2- to 4-fold across states, the report said.
"The U.S. still spends up to twice as much on health care as other high-income countries, but too often fails to deliver what people need — timely access to high quality, efficient health care," Maureen Bisognano, president and chief executive officer of the Institute for Healthcare Improvement, and a Commonwealth Fund Board and commission member, said in a release. "The places in the U.S. and around the world that set the benchmarks prove that it is possible to do better."
The report, "Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011," measures the US healthcare system across 42 key indicators of quality, access, efficiency, equity, and healthy lives. The scorecard compares US average performance with rates achieved by the top 10% of "U.S. states, regions, health plans, and hospitals or other providers, as well as from the top-performing countries," according to the report.
The 2011 score of 64 out of 100 was slightly below both the overall score of 67 in the first national scorecard, published in 2006, and the score of 65 from in the second scorecard, published in 2008. The authors note that latest data in the scorecard primarily fall between 2007 and 2009, before enactment of the Affordable Care Act. They also point out that provisions in the new law target areas for improvement in which the United States falls short, particularly in access to care, affordability of care, and support for more patient-centered, coordinated care.
Despite the overall score, the report found notable gains in quality of care in areas that have been the focus of public reporting or collaborative improvement initiatives. For example, 50% of adults with high blood pressure had it under control in 2007 to 2008 compared with only 31% in 1999 to 2000. Hospital quality indicators for treatment of heart attack, heart failure, and pneumonia, as well as prevention of surgical complications, have improved substantially across the country since hospitals began publicly reporting their quality data through a federal Web site.
"If we target areas where we fall short and learn from high-performing innovators within the United States, we should see significant progress in the future," said Commonwealth Fund Commission Chair David Blumenthal, MD, professor of medicine and healthcare policy at Massachusetts General Hospital/Partners HealthCare System and Harvard Medical School, Boston. "The Affordable Care Act and investments in information systems offer the potential for rapid progress in areas like adoption and use of health information technology, safer care, and premature deaths from preventable complications."
The Commonwealth Fund strongly supported passage of the Affordable Care Act.
The scorecard found that in many areas, US health system performance has either failed to improve or has declined over time.
By 2010, 81 million adults (44% of all adults younger than 65 years) were either underinsured or uninsured at some point during the year, up from 61 million in 2003. For those with insurance, premiums rose far faster than incomes. In 2003, a majority of people (57%) lived in a state where health insurance premiums averaged less than 15% of average (median) incomes. By 2009, only 4% of the population lived in such states. In addition, by 2010, 40% of working-age adults had medical debt or faced problems paying medical bills, which was up from 34% in 2005.
"The U.S. also does particularly poorly on measures of health system efficiency," according to a news release. "This area of the scorecard includes such issues as evidence of duplicative services, high rates of hospital readmissions, relatively low use of electronic information systems, and high administrative costs. This low score translates into significant costs to the health care system. For example, the scorecard finds that the U.S. could save $55 billion a year if it could lower insurance administrative costs to the average of administrative costs in other countries with mixed public-private insurance systems."
Other areas of concern include:
Of nonelderly adults, 44% report they did not have an accessible primary care provider in 2008, and only half of adults received all recommended preventive care.
The average US infant mortality rate is more than 35% higher than the rates achieved in the best states, and rates in even the best states are still twice as high as those in other countries.
Rehospitalization rates failed to improve and varied widely, with 20% of Medicare patients hospitalized for certain conditions or procedures readmitted within 30 days in both 2003 and 2009. Rates in the highest-rate regions were 50% higher than in the lowest-rate regions.
Conservative health policy leaders argue that Commonwealth Fund scorecards are biased. "They consistently downplay the incredible quality of care Americans receive when they are sick," Grace-Marie Turner, president of the Galen Institute, told Medscape Medical News. "We have higher rates of people surviving breast cancer, prostate cancer, and cardiovascular disease than anywhere in the world.
"Take the infant mortality statistics," she said. "In many other countries, a baby has to be alive for days before it's even counted as a live birth. These countries don't engage in the heroics we do to save babies. That's why their rate appears better than ours, but it's highly deceptive.
"We have problems that need to be fixed in healthcare," Turner said. "But trying to tell Americans that we have a terrible health system and disparaging it due to Commonwealth's political agenda is just not credible."
"This is just the latest installment of Commonwealth's continuing work to selectively criticize the private sector side of American healthcare," Thomas Miller, resident scholar at the American Enterprise Institute told Medscape Medical News. "Note that the fund doesn't invest the same effort in criticizing the fee-for-service Medicare or expanding Medicaid and CHIP programs, or the hoped-for fuller implementation of the Affordable Care Act, because those are considered politically occupied territories. These scorecards use flawed measures, skewed 'evidence,' and rigged comparisons."